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Previous Volume 333:964-969 October 12, 1995 Number 15 Next

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ABSTRACT

Background The effect of smoking on thyroid function is controversial, and its effect on thyroid hormone action is unknown. We investigated the effects of cigarette smoking in women with various grades of hypothyroidism and in normal women.

Methods We studied 138 normal women and 135 women with primary hypothyroidism, of whom 84 had subclinical hypothyroidism and 51 overt hypothyroidism. Sixty of the women with hypothyroidism were reevaluated during thyroxine therapy. The women were categorized as smokers or nonsmokers according to their responses to a questionnaire. Thyroid function was evaluated by measurements of serum thyrotropin, free thyroxine, and triiodothyronine. Peripheral thyroid hormone action was assessed by a clinical score and measurements of ankle-reflex time and serum lipids and creatine kinase.

Results Among the women with subclinical hypothyroidism, the smokers had a higher mean (±SD) serum thyrotropin concentration (21.3±16.6 vs. 12.7±7.2 mU per liter, P = 0.004) and a higher ratio of serum triiodothyronine to serum free thyroxine (by 30 percent, P = 0.003) than the nonsmokers. Their serum concentrations of total cholesterol and low-density lipoprotein (LDL) cholesterol were higher (by 16 percent, P = 0.013; and 28 percent, P = 0.003, respectively). Among the women with overt hypothyroidism, the serum concentrations of thyrotropin, free thyroxine, and triiodothyronine were similar in the smokers and nonsmokers. As compared with the nonsmokers, the smokers had a clinical score indicating a greater degree of hypothyroidism (P<0.001), higher serum concentrations of total and LDL cholesterol (by 25 percent, P<0.001; and 24 percent, P = 0.002, respectively), longer ankle-reflex time (by 25 percent, P<0.001), and higher serum concentrations of creatine kinase (by 236 percent, P<0.001). There were dose–response relations between smoking and serum concentrations of total and LDL cholesterol, serum creatine kinase concentrations, and ankle-reflex time in the women with overt hypothyroidism, and between smoking and serum concentrations of total and LDL cholesterol in the women with subclinical hypothyroidism.

Conclusions Smoking increases the metabolic effects of hypothyroidism in a dose-dependent way. This may be explained by alteration of both thyroid function and hormone action.

Source Information

From the Division of Endocrinology, Diabetology, and Metabolism, Department of Medicine (B.M., H.Z., J.-J.S.), and the Hormone Laboratory, Department of Chemical Pathology (P.H.), University Hospital, Basel, Switzerland; and the Wolfson Research Laboratories, Department of Clinical Chemistry, Queen Elizabeth Medical Centre, Egbaston, Birmingham, United Kingdom (J.G.R.).

Address reprint requests to Dr. Müller at the Division of Endocrinology, Diabetology, and Metabolism, Department of Medicine, University Hospital, Petersgraben 4, CH-4031 Basel, Switzerland.

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